Nursing interventions in mental health and psychiatry: Content analysis of records from the nursing information systems in use in Portugal.

WHAT IS KNOWN ABOUT THE SUBJECT?: Planning and implementation of care are based on the selection and application of nursing interventions, which correspond to a key element in the nursing process. No information was found in the literature about which major nursing interventions are documented by nurses working in psychiatric wards. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite the criteria applied to the intervention records' analysis may have led to the exclusion of certain important aspects of mental health nursing, this study provides information on some of the most relevant interventions in the field of psychiatric and mental health nursing documented in Portugal, placing them into the different steps of the nursing process. This study revealed the lack of standardized language used by nurses in intervention definitions, which results in the use of varied terminology to describe the same intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study constitutes an important contribution towards the standardization of language used by mental health nurses in intervention definitions, which may lead to the production of health indicators that will show policymakers the importance of nursing care towards population health. This study also contributes to the improvement of nursing informatics systems in use in psychiatric departments, particularly through the differentiation between different types of intervention, placing them into the proper steps of the nursing process. The problems identified in this study regarding nursing documentation may suggest that more training for professional nurses in the field of intervention formulation is needed. ABSTRACT: Introduction The nursing intervention corresponds to a key element in the nursing process. No information was found in the literature about which major interventions are documented by nurses working in psychiatric wards. Aims (a) To identify the interventions documented by nurses in Portugal that respond to nursing needs within the scope of psychiatric nursing; (b) to identify the main problems in identifying these interventions. Method A descriptive study combining: (a) quantitative content analysis of intervention records identified by mental health nurses in Portugal and (b) a focus group meeting with 14 nurses exploring the results of the first study phase. Results The 2,881 initial intervention records were systematized into 198 intervention categories. Some problems in the interventions' documentation by nurses were identified. Discussion Despite certain important aspects of mental health nursing may have been excluded, this study provides information on some of the most relevant interventions in the field of mental health nursing documented in Portugal. Implications for practice This study may offer an important contribution to the improvement of nursing informatics systems and the production of health indicators that reveal the contribution of nursing care towards population health.

Associations between psychiatric inpatient bed supply and the prevalence of serious mental illness in Veterans Affairs nursing homes.

OBJECTIVES: We assessed whether reductions in inpatient psychiatric beds resulted in transinstitutionalization to nursing home care of patients with serious mental illness (SMI) within the Veterans Health Administration (VHA). METHODS: We assessed trends in national and site-level inpatient psychiatric beds and nursing home patient demographics, service use, and functioning from the VHA National Patient Care Database, VHA Service Support Center Bed Control, and VHA Minimum Data Set. We estimated nursing home admission appropriateness using propensity score analyses based on Michigan Medicaid Nursing Facility Level of Care Determinations ratings. RESULTS: From 1999 to 2007, the number of VHA inpatient psychiatric beds declined (43,894-40,928), the average inpatient length of stay decreased (33.1-19.0 days), and the prevalence of SMI in nursing homes rose (29.4%-43.8%). At site level, psychiatric inpatient bed availability was unrelated to SMI prevalence in nursing home admissions. However, nursing home residents with SMI were more likely to be inappropriately admitted than were residents without SMI (4.0% vs 3.2%). CONCLUSIONS: These results suggest the need for increased attention to the long-term care needs of individuals with SMI. Additional steps need to be taken to ensure that patients with SMI are offered appropriate alternatives to nursing home care and receive adequate screening before admission to nursing home treatment.

The Mental Health Care Act No 17 - South Africa. Trials and triumphs: 2002-2012.

The Mental Health Care Act 17 of 2002 (MHCA) was promulgated in 2004. It has been hailed as one of the most progressive pieces of mental health legislation. A true measure of its merit is the degree to which it has transformed mental health services and in particular improved the quality of care. This paper will describe the impact of the Act on mental health care service delivery in the country. Literature pertaining to the MHCA published from 2006-2012, a report compiled by the South African Society of Psychiatrists and the results of a national survey conducted among Heads of Departments of Psychiatry, Mental Health Review Boards and Provincial Directors of Mental Health was reviewed. The MHCA has been successful in shifting the emphasis of care from psychiatric institutions to general hospitals. However, the integration of services has been hampered by infrastructure constraints and shortages of mental health personnel. It has been less successful in integrating mental health care into primary health services where the focus remains largely on the pharmacological maintenance treatment of the chronically mentally ill. Little attention has been given to the health promotion, disease prevention and rehabilitation aspects of care. Mental health review boards contend with limited resources, administrative challenges and limited political support. Isolated pockets of success characterised the implementation of the MHCA across the country. Greater investment of resources is needed to ensure the comprehensive implementation of the Act.

Impact of capacity reductions in acute public-sector inpatient psychiatric services.

OBJECTIVE: This study tested the hypothesis that reductions in acute public-sector psychiatric inpatient capacity in a major urban area would be associated with negative impacts on patients and the community. METHODS: The impact of two discrete service changes that reduced acute inpatient capacity by 50% in a single public-sector general hospital setting was examined. Indicators of impact were obtained from existing administrative databases for a 33-month period. Indicators included measures of utilization and case mix on the acute inpatient and psychiatric emergency services, suicides among community mental health clients, and psychiatric evaluations conducted in county jails. RESULTS: Reductions in inpatient capacity were not associated with hypothesized negative impacts, such as increased demand for psychiatric emergency services, decreased access to emergency or inpatient services, or increased recidivism to inpatient care. Similarly, neither the number of suicides among community mental health clients nor the number of jail psychiatric evaluations increased after capacity reduction. CONCLUSIONS: Data from a single urban public-sector setting suggest that acute inpatient psychiatric capacity may be reduced without negative impacts on patients or the community. In this setting, collaboration between inpatient and outpatient providers to speed discharge facilitated reductions in inpatient length of stay that made it possible to serve the same number of patients with fewer resources. Other service system adjustments may be more appropriate in other settings, and alternative approaches to reducing utilization of high-cost inpatient care warrant examination.

Utility and sufficiency of psychiatric inpatient units in general hospitals: a cross-sectional study in Tokyo.

In order to investigate the utility and sufficiency of psychiatric beds in general hospitals (GHP beds), a cross-sectional study was performed in general hospitals all over Tokyo. Reasons for admission were acute-phase treatment (43%), medical comorbidity (15%), electroconvulsive therapy (13%), differential diagnosis (12%), and others (17%). The number of patients who could not be admitted to GHP beds despite appropriate reasons for admission was estimated to be greater than that of inpatients without indispensable reasons for admission to GHP beds on the day of the survey. GHP beds played the expected roles, and were in short supply.

Implications of bed reduction in an acute psychiatric service.

OBJECTIVE: To evaluate the impact of psychiatric inpatient bed closures, accompanied by a training program aimed at enhancing team effectiveness and incorporating data-driven practices, in a mental health service. DESIGN AND SETTING: Retrospective comparison of the changes in services within three consecutive financial years: baseline period - before bed reduction (2006-07); observation period - after bed reduction (2007-08); and intervention period - second year after bed reduction (2008-09). The study was conducted at Cramond Clinic, Queen Elizabeth Hospital, Adelaide. MAIN OUTCOME MEASURES: Length of stay, 28-day readmission rates, discharges, bed occupancy rates, emergency department (ED) presentations, ED waiting time, seclusions, locality of treatment, and follow-up in the community within 7days. RESULTS: Reduced bed numbers were associated with reduced length of stay, fewer referrals from the community and subsequently shorter waiting times in the ED, without significant change in readmission rates. A higher proportion of patients was treated in the local catchment area, with improved community follow-up and a significant reduction in inpatient seclusions. CONCLUSION: Our findings should reassure clinicians concerned about psychiatric bed numbers that service redesign with planned bed reductions will not necessarily affect clinical care, provided data literacy and team training programs are in place to ensure smooth transition of patients across ED, inpatient and community services.

Shrinking inpatient psychiatric capacity: cause for celebration or concern?

This issue brief examines reported capacity constraints in inpatient psychiatric services and describes how these services fit within the continuum of care for mental health treatment. The paper summarizes the type and range of acute care services used to intervene in mental health crises, including both traditional hospital-based services and alternative crisis interventions, such as mobile response teams. It reviews historical trends in the supply of inpatient psychiatric beds and explores the anticipated influence of prospective payment for inpatient psychiatric services under Medicare. The paper also considers other forces that may affect the need for and supply of acute mental health services, including key factors that could improve the quality and efficiency of inpatient psychiatric care.

Stressed out.

With mental health services shrinking, emergency departments are deluged by patients they were never designed to handle."The safety net for these poor people is unraveling," says Alicia Boccellari of San Francisco General Hospital. Her hospital and several others are confronting the crisis with little help from the government or private insurers.

An aged persons mental health service in remote Victoria.

OBJECTIVE: To describe an aged persons mental health service in the Sunraysia district in remote Victoria. CONCLUSION: The aged persons mental health community team undertakes the bulk of the service's work. The data for 2 years are presented and demonstrate how effective the team is. Good relationships and linkages have been built with the local hospital, general practitioners, aged residential care services and the local aged care assessment service. During the 2 year period, very few elderly patients were admitted to the inpatient psychiatric facility and patients suffering from dementia were rarely admitted.

[Shortage of supported housing for patients with mental disorder and substance abuse]. / Udekket behov for skjermede boliger for alvorlig psykisk syke med rusmisbruk.

BACKGROUND: Some patients with comorbidity of severe mental illness and substance abuse--often called patients with dual diagnosis--are in need of supported housing. The extent of this need was one of the aspects of a survey conducted by the Norwegian Board of Health in 1999. Findings concerning housing from one part of the survey, which included inpatients in psychiatric hospitals and clinics, are presented in this paper. MATERIAL AND METHODS: The survey was performed as a cross-sectional study of 310 dually diagnosed inpatients in Norwegian psychiatric institutions on 27 January 1999. Their housing at the time of admission, planned housing at discharge and ideal housing in the opinion of the clinician who knew the patient best--mainly a psychiatrist--were registered. RESULTS: At admission, 3% were living in supported housing, while such housing was planned for 10% on discharge. However, clinicians evaluated that 43% ideally were in need of supported housing, most of them with support at daytime, but a substantial number needed support night and day. INTERPRETATION: The need for supported housing for patients with dual diagnosis is of significant magnitude and represents a challenge for communities as well as psychiatric services.

Availability and performance of psychiatric acute care facilities in California from 1992 to 1996.

OBJECTIVE: The acute care psychiatric hospital industry has been challenged by managed care, government policies, and marketplace competition to control rising costs. This study examined changes in the availability and performance of acute care psychiatric delivery facilities in California between 1992 and 1996. METHODS: A retrospective longitudinal research design was used. Data on facilities, licensed psychiatric beds, discharged patients, days of care, occupancy, average length of stay, licensure, and type of ownership for the years 1992, 1994, and 1996 were purchased from the California Office of Statewide Health Planning and Development. Data were analyzed using numerical description and percent-change calculations. RESULTS: Between 1992 and 1996 licensed beds, days of care, and average length of stay decreased in acute psychiatric facilities and services, while psychiatric discharges and facility occupancy increased. The for-profit sector and the specialty acute care sector experienced large decreases in facilities, licensed beds, days of care, and average length of stay. The generalist sector-general psychiatric units licensed within acute general hospitals-and not-for-profit facilities experienced large increases in discharges. CONCLUSIONS: Challenges to institution-based services for the mentally ill population now extend beyond the state hospital system to include community-based acute care psychiatric hospital services. Recent declines in the for-profit, acute care psychiatric hospital specialty sector and the success of the generalist and not-for-profit sectors demonstrate the lack of uniform responses to environmental pressures. However, changes in federal Medicare reimbursement policy enacted in the Balanced Budget Act of 1997, as well as competition from alternative providers, are likely to result in further closures of all types of acute care psychiatric facilities over the next few years.

Procedimientos, técnicas e información: la psicoterapia de grupo y el concepto de "enlace" en el contexto hospitalario / The group-psychotherapy and the conception of linking in the in-patient medical care

La psicoterapia de grupo (PG) surge con Joseph Pratt en 1904, en el seno de un hospital general para enfermos de tuberculosis crónica, siendo aplicada luego en pacientes psicóticos por Lazell y más tarde a pacientes con diversos diagnósticos, tales como; cáncer, SIDA, affecciones cardiovasculares, diabetes, nefropatías, etc. el concepto de enlace surge en 1930, retoma el viejo dilema mente-cuerpo y coadyuva de manera efectiva a interconectar y comunicar la psiquiatría con otras especialidades médicas y con la medicina de cuidado primario. Diversos modelos de enlace, tales como la interconsulta, el propio enlace, el puente psiquiátrico, el modelo híbrido o el autónomo, inciden a todos los niveles del hospital general, constituyendo y dando pie a la subespecialidad en el campo del enlace. La aplicación de la PG hospitalaria, precisa de su formulación a tiempo limitado, objetivos focalizados y modulación de la profundidad de la regresión, así como trascender el encuadre, para establecer enlace, como un requisito indispensable. El presente trabajo plantea, a partir de una contextualización de ambos conceptos, la utilidad de la función del enlace como intercomunicador entre las disciplinas de salud mental así como entre éstas y otras especialidades médicas, a nivel de hospital general

The relationship between supply and hospitalization rates for mental illness and substance use disorders.

This study investigated the extent to which mental illness and substance use hospitalization rates were related to the supply of psychiatric treatment services. Supply variables, notably the per capita rate of psychiatrists, primary care physicians, and specialty units, were strongly related to mental illness and substance use hospitalization rates to acute care hospitals across 114 small geographic areas in Iowa. The supply of outpatient services was not related to hospitalization rates. The need to study the reliability of patient assessment processes, refine guidelines and admissions criteria, and understand the contributions of supply variables to hospitalization rates are indicated by these results. A conceptual model is offered within which the dynamic cycle from patient functioning to service delivery may be framed.

The array of psychiatric services in general hospitals.

This paper examines the frequency with which general hospitals with inpatient psychiatric units provide psychiatric emergency, outpatient, and partial hospital care. An analysis is presented of data from the 1988 American Hospital Association Annual Survey of Hospitals focusing on the number and proportion of general hospitals with psychiatric units that offer psychiatric emergency, outpatient, and partial hospital services. The vast majority (82.6%) of general hospitals with psychiatric units provided psychiatric emergency room services, approximately half (50.3%) provided psychiatric outpatient services, and slightly over a third (37.9%) offered partial hospitalization services. General hospitals with psychiatric units were more likely to provide outpatient psychiatric services if they were under private nonprofit or nonfederal governmental control than if they were under private for-profit control. General hospitals with inpatient substance abuse treatment services were more likely to provide complementary outpatient services than were general hospitals with inpatient psychiatric services (70.8% vs 50.3%). The results indicate that at half of the hospitals with psychiatric units, discharge planning necessarily involves referring patients outside of the hospital for continuing care.